The price supervisor Stefan Meierhans (53) has found “strong indications” that the hospitals are paying too much for services that they provide to those with additional insurance. The Federal Financial Market Supervisory Authority Finma, which criticized intransparent and unfoundedly high bills in December, was already aiming in the same direction.
The information from the price supervisor would indicate that the additional insurance tariffs would clearly exceed the costs of benefits for those with additional insurance reported by the hospitals, writes Meierhans in a newsletter on Tuesday. “This creates incentives for patients with additional insurance to carry out medical treatments even if there is no compelling medical indication,” it says.
In plain language: Hospitals carry out examinations that are not necessary. Or they prescribe medication it doesn’t need. And they charge tariffs that are too high. They do this to fill the coffers – among other things at the expense of the general public.
Unnecessary treatments
“Since the unnecessary treatments are billed via the flat-rate per case of the basic insurance, this false incentive exacerbates the financial pressure on the basic insurance and contributes to the fact that the health insurance premiums rise unnecessarily”, so Meierhans in the newsletter.
But the supplementary health insurance tariffs are “nationwide” too high, the price monitor notes. The premiums for semi-private and private insurance are “not justifiable”.
For the assessment, the price monitor determined the effective case costs of 147 hospitals. The general basic care therefore averages 9,600 francs per case. For semi-private customers, however, there are additional services of 6745 francs each – for those with private insurance, the extras even amount to 8960 francs.
A tricky comparison
The names of the clinics are not mentioned in the report. The subject is too sensitive. But one thing is clear: the case costs vary from hospital to hospital. Strong even. The highest case costs in the semi-private department add up to almost 18,000 francs. They are almost twice as high as the effective additional case costs for semi-private treatment in the average hospital. And they are eight times as high as at the cheapest hospital (1959 francs).
The same picture for private patients: the average case costs that are incurred in addition to basic insurance are over 19,000 francs at the most expensive hospital. At the cheapest, however, less than 3000 francs.
“From the price supervisor’s point of view, it is extremely questionable whether the additional services provided by the hospitals compared to the services already paid for by the basic insurance, which after all include the entire operating costs as well as hotel and care services at a good level, can actually be worth that much”, it says in the newsletter.
Politics is required
The price monitor comparison is the first of its kind. The data on which the analysis is based was collected from the ten largest Swiss supplementary health insurers. In the run-up to the publication, some hospital lawyers apparently tried to withhold certain aspects of the study, as the newspapers of «Tamedia» report.
The price supervisor recommends adapting the legal framework “immediately”. “To reduce the tariffs across the board to a reasonable level.” But insurers and hospitals are also challenged. They should ensure more transparency, which Finma has already requested. (ise)